Provider Demographics
NPI:1568839090
Name:PILSEN-LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:PILSEN-LITTLE VILLAGE COMMUNITY MENTAL HEALTH CENTER, INC.
Other - Org Name:PILSEN WELLNESS CENTER, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESICENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:CISNEROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-579-0832
Mailing Address - Street 1:2319 S DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-4209
Mailing Address - Country:US
Mailing Address - Phone:773-579-0832
Mailing Address - Fax:773-579-0762
Practice Address - Street 1:3232 W 55TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-2638
Practice Address - Country:US
Practice Address - Phone:773-424-3060
Practice Address - Fax:773-424-3368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-01
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder